Intraosseous venous malformation of the clivus.
Adebayo Olusola Alade, Sofia Nunes, Manuela Mafra et al.
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Case in brief
A teenage female presented with a 1-month history of intermittent right-sided tongue numbness and twitching. Investigations, including laboratory tests and an electroencephalogram, were unremarkable. Brain MRI and CT scans revealed an expansile osteolytic mass in the clivus with a honeycomb pattern. A biopsy confirmed an intraosseous venous malformation. Due to the complexity of complete surgical resection, empirical propranolol therapy was initiated, leading to symptom resolution and slight lesion reduction over two years.
What made this case unusual
The imaging findings of a honeycomb pattern in the clivus are atypical for venous malformations, which usually present differently.
Diagnostic / clinical pearl
Clinicians should consider intraosseous venous malformations in patients with unexplained neurological symptoms and characteristic imaging findings.
Why it matters
This case highlights the importance of recognizing atypical imaging features that may indicate a venous malformation, guiding appropriate management strategies.